Safety Concerns Form

2. Please note that this form is not intended to be used for any situation that may be considered an emergency! Please call the department by phone for any serious problems that are in progress. This form is intended to relieve some of the call volume from the dispatchers so they can focus their attention on the most important calls.

4. Choose from the following:

   1. Radar Request
   2. Traffic Concerns
   3. Safety Concerns
   4. Street Light Outage
   5. Traffic Light Problems
   6. Missing Street Sign
   7. Missing Speed Limit Sign
   8. Other Concern (Explain Further)
6. Name*
7. Email Address*
9. Home Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
17. May we use your driveway when conducting radar?
    -- Select One --YesNoAt Times (Explain)
18. What time of day is the radar needed?
    -- Select One --MorningAfternoonEveningOvernightAll Hours
20. What is the location of the problem that needs to be addressed?
22. Any additional comments / information
24. Was this form helpful? What else would you like to see on this form?
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field